Employer'S Tax Reports Forms - Nevada Employment Security Division (Page 2 of 2) in pdf

Employer'S Tax Reports Forms - Nevada Employment Security Division Page 2

Employment Security Division

Contributions Section

*0*

500 East Third Street

Carson City, NV 89713-0030

(775) 684-6300

Wage Report

Use BLACK INK only. Instructions on separate page.

Please report any changes on the enclosed Employer's Report of Changes.

EMPLOYER ACCOUNT

FEDERAL I.D.

QUARTER

DELINQUENT

NO.

ENDING DATE

AFTER

Social Security Number

Employee Name

Total Tips Reported

Total Gross Wages + Tips

(LAST NAME | FIRST NAME | MIDDLE INITIAL)

DOLLARS

CENTS

DOLLARS

CENTS

TOTAL GROSS WAGES + TIPS THIS PAGE .................................................................................. $

NUMBER OF

WORKERS REPORTED

GRAND TOTAL GROSS WAGES + TIPS ALL PAGES ................................................................ $

Include the GRAND TOTAL on the Employer's Quarterly Report, Line 3.

PAGE

TOTAL PAGES

Authorized Signature: ________________________________________________________________

If Other Than Employer

Print Signer's Name/Title: _____________________________________________________________

Print Preparer's Name: ________________________________________________________

Employer's Phone Number/Email: ______________________________________________________

Preparer's Phone Number/Email: ________________________________________________

NOTE: Information collected may also be provided to various federal and state agencies as required or permitted by federal and state law.

*NEW0098*

FRAUD

Report suspected UI Fraud online at or call (775) 684-0475

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Employer'S Tax Reports Forms - Nevada Employment Security Division Page 2